Please consider consolidating regulatory actions on Licensing regulations.  DBHDS is trying to separate regulations into a general chapter and service specific chapters which no longer all align with other efforts to end certain services and establish others as part of Behavioral Health Redesign with DMAS.  This is inefficient and confusing.  We should be moving forward with one process that can both overhaul regulations while speaking to the services of Behavioral Health Redesign.

I appreciate the opportunity to provide feedback on the proposal to repeal 12VAC35-46 and 12VAC35-105 and restructure the Department of Behavioral Health and Developmental Services licensing regulations into a general chapter with multiple service-specific chapters.

Concerns:

1. Fragmentation of Regulations
   Splitting licensing rules into six separate chapters may create unnecessary confusion for providers and staff. Many providers operate across multiple service types (residential, crisis, case management, etc.), which will force them to cross-reference several chapters rather than using one integrated framework. This increases the risk of misinterpretation, inconsistency, and regulatory burden without clear benefit.

2. Timing with DMAS Behavioral Health Redesign
   The Department of Medical Assistance Services (DMAS) is still in the process of redesigning behavioral health services. The DBHDS licensing overhaul appears disconnected from this redesign effort. If the two processes move forward on separate timelines, providers will face overlapping but unaligned changes to regulations and service definitions. This timing could cause duplication, inefficiency, and added compliance costs during an already unstable transition period.

3. Regulatory Overload for Providers
   The system has seen a wave of new initiatives: Marcus Alert, crisis service transformation, new performance contract requirements, DBHDS risk management memos, and pending updates on case management. Adding a full licensing restructure at the same time may overwhelm providers and divert resources away from quality improvement and direct care.

4. No Planned Public Hearing
   Given the scale of this change, not holding a public hearing reduces transparency and limits meaningful input from those most impacted. Providers, families, and advocates deserve the opportunity for live discussion and feedback before a decision is made.

Recommendations:

• Consolidate the Process: Align the DBHDS licensing overhaul with DMAS Behavioral Health Redesign so that regulations and services are integrated into a single, coordinated framework.

• Phase Changes Gradually: Consider targeted updates to address urgent gaps (e.g., new service types) but delay full restructuring until DMAS redesign details are finalized.

• Maintain a Central Framework: If DBHDS proceeds with service-specific chapters, ensure there is one consolidated reference guide or integrated portal that shows how requirements interact across service types.

• Add a Public Hearing: Provide stakeholders the opportunity to discuss these changes openly before they move forward.

• Conduct Impact Analysis: Before adoption, DBHDS should assess the administrative and financial impact on providers, particularly smaller CSBs and community agencies already under resource strain.

Conclusion:
While the goal of clarity and service-specific detail is understood, moving forward now with this broad regulatory overhaul risks creating confusion, duplication, and instability across the system. A more coordinated, phased approach that aligns with DMAS redesign would better serve providers, individuals, and the Commonwealth.

Thank you for the opportunity to post comments. 

Please consider consolidating regularity actions on Licensing regulations. Separating regulations in a general chapter may/will be confusing. DBHDS and DMAS partnering together to have one uniform process in overhauling regulations will be beneficial for all. 

Our agency has concerns about moving forward with an overhaul of the regulations, particularly given the many changes underway at the Department of Medical Assistance (DMAS). The DMAS redesign changes are significant, and moving forward simultaneously could create confusion and inconsistency for providers. This would place an added burden on agencies and staff who are already working hard to learn and adapt to the coming DMAS changes. We believe it would be most effective to allow DMAS redesign to be finalized before undertaking additional regulatory overhauls.

If DBHDS does decide to continue with revisions at this time, we respectfully request that the new regulations be aligned with DMAS and the MCO’s to ensure consistency across agencies.

As a provider committed to trauma-informed, person-centered care across both adult and children’s services, I respectfully urge DBHDS to reconsider the decision to merge regulatory oversight for these distinct populations under a single Residential Services chapter.
While I appreciate the intent to streamline and clarify licensing expectations, combining children’s and adult regulations introduces unnecessary complexity and operational risk. These populations differ significantly in developmental needs, legal protections, supervision requirements, and therapeutic approaches. Merging them into one chapter—however well-intentioned—creates ambiguity for providers, especially those serving both groups.
Key concerns include:
• Policy Clarity: Providers must now parse which provisions apply to children, adults, or both—without the benefit of separate chapters. This increases the risk of misinterpretation and noncompliance.
• Staff Training Burden: Training must now be bifurcated internally, with staff needing to distinguish between overlapping but divergent standards within a single regulatory document.
• Audit Vulnerability: Licensing specialists may interpret provisions differently depending on population served, creating inconsistency and confusion during audits.
• ISP and Service Planning: Children’s services often require more intensive coordination with guardians, schools, and legal systems. Adult services emphasize autonomy and recovery. These distinctions deserve regulatory separation.
• Trauma-Informed Practice: Children and adults experience and respond to trauma differently. Regulatory language should reflect these nuances explicitly, not implicitly.
I strongly recommend reinstating separate chapters for Children’s Residential Services and Adult Residential Services, or at minimum, embedding clearly demarcated subsections within the Residential chapter that distinctly address each population. Doing so would preserve clarity, reduce administrative burden, and better support providers in delivering safe, dignified, and developmentally appropriate care.
Thank you for your consideration.

The DBHDS plan to separate the Licensing Regulations into a general chapter and separate service-specific chapters does not align with the DMAS Behavioral Health Redesign efforts.  PWC CSB supports moving forward with one process that can both overhaul regulations while speaking to the services of Behavioral Health Redesign.

In response to the Notice of Intended Regulatory Action (NOIRA) for the Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services, 12 VAC 35- 105-10, et seq, please reconsider the proposed action of separating regulations into a general chapter and service specific chapters.  With pending regulation and service changes related to the Behavioral Health Redesign, the proposed action action would not be in alignment with the ending of certain services and establishing of other services in the Redesign model. We should be moving forward with one process that can both overhaul regulations while speaking to the services of Behavioral Health Redesign. 

We support DBHDS's intent to structure the licensing regulations into separate chapters. We are supportive of proposed actions Virginia's behavioral health and developmental disability services for long-term modernization. We urge DBHDS to be mindful when creating the chapters to clearly distinguish between services that may fall under two categories (for example crisis residential services which are both residential and crisis).

The NOIRA bulletin mentions reviews that have occurred as far back as 2017. We urge DBHDS to thoughtfully review the previous drafts shared with the public. Many codes and regulations have changed between 2017 and 2025 and the some of the content in the draft regulations and comments from 2019 and 2021 may be obsolete.

Before moving forward with overhauling the licensing regulations, DBHDS should assess the administrative burden and financial impact on providers, who are already under resource strain. The greatest concern is that DBHDS is proposing regulation changes at the same time DMAS is proposing the BH Redesign. These plans would not be in alignment with each other, creating confusion and inconsistency. If these two proposals move forward separately, the regulations will be overlapping yet unaligned. This a big problem. Please consider the timing.

DBHDS is proposing major regulation changes at the same time that DMAS is proposing BH redesign. These actions occurring at the same time without being in alignment will create additional administrative and financial burdens on providers who are already under resource strain. It will also create inconsistency and inefficiency. Please consider the timing of this initiative so one process can be established to overhaul the regulations while taking into account the BH redesign. 

VAC35-106-30.C.3 States that the non-residential providers license identifies the maximum capacity of enrolled individuals the provider may serve.  I don't see that on our license - will this be added?

12VAC35-106=250 - Are these requirements for contents of personnel files intended for all provider staff or just those working in direct support roles?

12VAC35-106-290.B.2.a Are all providers staff required to be CPR certified including those who work in Administrative roles?  Are all direct support staff required to be CPR certified?

12VAC35-106-290.B.2.b  Is medical administration training required for all direct support staff - even those who do not administer medication?